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Ask Anything: 10 questions with Tina Dennis, Critical Care Nurses Association

Tina Dennis, with the Greater Raleigh Area Chapter of the Critical Care Nurses Association, answers your questions about working in a high-pressure job, helping sick patients and nurses' pay.

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Tina Dennis
How do you maintain balance and take care of yourself while working in such a high pressure, important job. You literally hold people's lives in your hands and we all owe you a debt that cannot be repaid. – Dan Thompson, Chapel Hill

First of all, what a kind question to ask, so thank you. Critical care nurses receive extensive education and hands-on training. The nursing staff works as a team. Depending on the patients diagnoses there are several specialists working with the patient.

Where I work, we have critical care intensivists, neurosurgeons and neurologists, trauma specialists, orthopedic surgeons, cardiologists, hematologists, infectious disease specialists, etc. The team also consists of interdisciplinary staff such as respiratory therapists, social work, chaplain services, dieticians, pharmacists, physical therapists, occupational therapists and speech pathologists. So, it really is a team approach in critical care.

Maintaining balance and taking care of oneself is always a challenge. In such a stressful environment, one must try to keep work at work and home is home. Working as a team helps in that you can rely on your resources and experts and feel good that the best care was given.

Having a great boss or management team and supportive family at home are also vital. And even though we hear this in every situation, or aspect of lives, routine exercise, good eating habits and getting plenty of sleep are essential.

Do you get attached to any of your patients? Does it make you upset when you lose one? – Erika Hess-Raines, Clayton

Great question. It's easy to say “don’t’ do it," but it's hard to actually do. Sometimes we do get a little attached, and the patient, their family or loved ones have an effect on us. I think there are people who come into your life and you remember them for a reason, some purpose that may not be apparent right then and there.

Later, in a similar situation, you remember them and it makes you more humble, perhaps more understanding, more compassionate. Certain people and situations touch your heart; I can think of several patients and their families I will always remember.

My background is neurocritical care, and we see a lot of death and dying and devastatingly sad situations. Working in such a place, we have to understand that even with the best team and the best medicine, at times, it is not enough to make the impossible possible.

Sometimes the role of the critical care nurse is not to heal or make better, but to help the patient and family through the dying process, help them to better understand the things that have occurred, what interventions have taken place, and provide a respectful, peaceful death.

Tina, what is the best way to deal with a sick person whether they are critical or just sick? It seems like no one ever knows what to say except "How are you feeling?" and everyone knows the answer to that is "bad." – Jane Smith, Fuquay-Varina

Hmmm ... thinking from the perspective of you as a family member or loved one who has a sick or critically ill patient in the hospital, it seems you are asking how best can you be of help, assistance or provide comfort and support?

The bottom line is you want them to know you care, but don’t want to add to their burden whether it is physical and/or emotional. And with that being said, there are many ways you can show that and they would depend on a variety of things.

For example, you visit your friend who is in critical care; he may just have experienced a large stroke. You walk in and he looks terrible, he is alert and awake, but is gray in color, oxygen is flowing through a tube in his nose, he is unable to move the left side of his body, and he is hooked to lots of equipment with alternating red and green flashing lights.

Gee, it is obvious he feels awful, and you are right, it would seem ridiculous to ask the typical question “How are you feeling?" The fact that you came to visit means a lot. Maybe sit quietly at his side, ask if there is anything you can do for him or his family, feed and walk his dog, make a meal for his family, or help his kids with their.

Sometimes if you can take some of the burden off the family members, it not only shows you care, but you relieve the patient from their worries of burden they feel they are causing their loved ones. You can also ask to speak to a hospital chaplain; they are not just there to help us with our spiritual needs. They are a wonderful source of support to all of us and can often times help you say just the right things in the right way.

Ask the patient (if they are well enough to speak) what is going on, what is happening. Sometimes when the patient verbalizes what has happened to them, it helps them come to terms with their illness. In the example of a stroke, lifestyle changes may need to take place. And finally, simply just listening is always good. Often patients need to express their anxiety, fears, concerns, and it is comforting for them to have a someone to talk to.

If a patient is badly hurt and/or in a large amount of pain, they may say "Let me die," but if they have a good chance of recovery what do you say or do? – Ted Demas, Durham

It is often quoted that patients only hear about 10 percent of what their physician tells them. Most likely, this is because they are overwhelmed by the information and the situation. Therefore, communication, continued reassurance and active listening skills are crucial.

Along with appropriately addressing acute or chronic pain issues, at times there are underlying anxieties or fears that heighten pain and comfort issues. At the hospital where I work, we not only have wonderful chaplain/spiritual care services, but there are neuropsychologists and psychiatrists who can dig deeper into some of these issues and provide specific treatment and intervention.

I have always had the heart to help people and thought about nursing several times, but I just do not think I can handle some of the "bodily" issues that come with nursing. How do you get past that or is it something you are just born with? – Tina Barham, Bunn

Oh, I am so glad you asked this as this is very common. One of the most wonderful things about nursing is that there is such a variety of areas to go into. Thus, you don’t have to go into an area where you may encounter those issues.

Nursing is not limited to just the hospital setting. There is school nursing, nursing instructors, nursing research, mental health, working with physicians in an office or clinic setting, chemotherapy nursing and much, much more! Now, if you think you might be able to get past the “bodily” issues, my suggestion would be to shadow a few nurses in fields you may be interested in.

I will give my husband as an analogy. He can’t stand blood and guts and “bodily” issues. I had Cesarean sections with both of my children, and he was right there with me in the operating room. There were, as one can imagine, a variety of “bodily issues” and while he saw it, it didn’t bother him, because he was so focused on the baby.

Further, when you bring the baby home, there are lots of “bodily issues,” i.e. messy diapers, throw up, etc. With babies and children, as parents, you get used to it; it is part of the job; it becomes natural. The same is true with nursing. My advice to you is to go out there and see; you may surprise yourself.

What advice would you give to someone who is interested in the nursing field? I, in particular, am unhappy with my current job and have been thinking of a career change. My current job is impersonal and I stare at a computer all day. – Kimberly, Raleigh

Go for it! I have been a nurse for 18 years now, and I can honestly say I wouldn’t want to be anything else. I have been blessed to work with wonderful people and in a wonderful place, and I am very passionate about what I do. I think that is the key – you have to find what makes you tick, what keeps your interest, what you are passionate about.

Give yourself time, because in a field as diverse as nursing, it may take some time for you to find your niche. Locate a nurse who works in a field that you may be interested in, and ask to shadow them. Working with patients and their families is rewarding, as is collaborating with other nursing staff, physicians and members of the team. Medicine is ever changing and you will never get bored! I learn something every day!

How do you think working conditions can improve for nurses so they won't leave the profession? And do we need to pay nursing teachers more? – David Ferguson, Raleigh

Second part of the question first: Yes, we should pay nursing teachers more. There is a nursing shortage, and an even worse shortage of nursing instructors. I wish we could pay all types of teachers more; they have a huge responsibility and there is not enough to entice people to go into the field of education.

AACN (American Association of Critical Care Nurses) has something called a “Healthy Work Environment” program. It is a multi-year, multi-pronged initiative to engage not only nurses, but also employers. The document that best describes this effort can be found at the AACN Web site: http://classic.aacn.org/aacn/pubpolcy.nsf/Files/HWEStandards/$file/HWEStandards.pdf. An additional document that summarizes the program can be found at: http://classic.aacn.org/aacn/pubpolcy.nsf/Files/HWEBackgrounder/$file/HWEBackgrounder.pdf

This is a great question, because as nurses are in short supply, retention and recruitment efforts need to be examined. It is everyone’s responsibility to not only recognize the need for a good physical environment in which to work in, but its links to patient safety and nurse retention and recruitment. The intricacies of good leadership, communication, clinical skills, appropriate staffing, nurse competencies, collaboration with other interdisciplinary team members, meaningful recognition of the needs and contributions of the entire team, the patient and their families all have much to do with creating a good place in which to work.

Where I am employed, we are in the midst of implementing Shared Governance for nursing. This is where the bedside nurse in collaboration with their unit management and senior administration has shared decision making; a way to give the bedside nurse a voice.

I'm currently taking a CNA1 class. How much education do you need to become a critical nurse? Will a two-year associate's degree (RN) do or do you need a BSN? – Daniel M., Raleigh

Well, having fairly recently obtained my master’s in nursing, I have to advocate that higher education is always better. Down the road if you want to advance into teaching, administrative positions, or Advance Practice Nursing, you will need to go back for your BSN. So, if you can, enter a four-year BSN program to start with; it may also give you an edge in the hiring process.

Having said that, however, you don’t have to have your BSN to enter the critical care arena. A two-year degree will work. What you need to look for is a place where as a new grad you will have an extensive orientation program. Many facilities offer a Fellowship program, or new graduate nurse program, where the length of training is up to six months. These programs integrate classroom learning, with hands-on skills lab training as well as one-on-one mentoring at the bedside.

How do you think Press-Gainey is affecting nursing? – Sandra S. Denmark, Benson

It is making us all more aware of why we are nurses – and that is to provide excellent patient care. Nurses want to make a positive difference. But we work in an ever-changing, rapidly advancing, highly regulated, risky, industry. If we don’t look from the outside in and ask critical questions, we won’t see our flaws, we won’t know what is wrong.

By looking specifically at certain aspects, we can focus our attention on the areas that need it most. And this goes back to question No. 7, if we partner with our hospital leadership to examine staff perceptions and improve areas that need attention, and then ultimately, patient care will be improved.

I am currently in school majoring in the Associates Degree in Nursing. I join the nursing program in August 2010. I am considering going into the ER/Trauma or Critical area. What advice do you have for those of us just getting started? – Chasity Hall, Pinehurst

Similar to what I said in  No. 8, look for a hospital that values nursing, is strong on educational programs and has support for the new graduate. Some hospitals require a few years of experience before entering these acute areas. Others have specifically designed fellowship/internship programs for critical care and emergency department.

To decide between the two areas, I would suggest you shadow in both. Start at the beginning of the shift and spend at minimum of four hours. Carefully observe the staff, interactions and collaborations, and ask lots of questions. People go to work in a certain place for several reasons: the available shift, the environment, the team you will work with, the hospital and the type of nursing. All of these are important, and you can glean a lot from watching what a typical day is like; and ask yourself – am I inspired there?

Lastly, don’t ever think you shouldn’t stop learning. Both in the emergency department and critical care areas, it is essential to have a good foundation of anatomy, physiology and pathophysiology, as well astute assessment skills, and understanding of diagnostic procedures, and the management of multiple, multiple disorders. So, don’t sell back those giant 4-inch nursing books yet.

There are also two great associations you can join that will provide you with resources, journals and networking opportunities. For critical care, AACN (American Association of Critical Care Nurses); their Web site is http://www.aacn.org. And for Emergency Nursing, the ENA (Emergency Nurses Association); website: http://www.ena.org/. Good luck and I wish you the best!

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